Nursing Elites

1. A client with congestive heart failure taking digoxin reports nausea and refuses to eat breakfast. Which action should the nurse take first?

• A. Encourage the client to eat the toast on the breakfast tray.
• B. Administer an antiemetic.
• C. Inform the client's provider.
• D. Check the client's apical pulse.

Correct answer: D

Rationale: The correct action for the nurse to take first is to check the client's apical pulse. Nausea can be a sign of digoxin toxicity, and one of the early signs of digoxin toxicity is changes in the pulse rate. By checking the client's apical pulse, the nurse can assess if the digoxin level is too high. Encouraging the client to eat or administering an antiemetic may not address the underlying issue of digoxin toxicity. While informing the provider is important, assessing the client's condition through checking the apical pulse should be the immediate priority.

2. A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects?

• A. Insomnia
• B. Hypotension
• C. Bleeding
• D. Constipation

Correct answer: C

Rationale: The correct answer is C: Bleeding. Clopidogrel is an antiplatelet medication that works by preventing platelets from sticking together and forming clots. Therefore, one of the main adverse effects of clopidogrel is an increased risk of bleeding. Insomnia (Choice A), hypotension (Choice B), and constipation (Choice D) are not commonly associated with clopidogrel use. Monitoring for signs of bleeding, such as easy bruising, petechiae, or prolonged bleeding from minor cuts, is crucial when a client is taking clopidogrel.

3. A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects?

• A. Thrombophlebitis
• B. Hyperactive reflexes
• C. Muscle weakness
• D. Hypoglycemia

Correct answer: C

Rationale: The correct answer is C: Muscle weakness. Chlorothiazide, a thiazide diuretic, can lead to hypokalemia, which can cause muscle weakness. Thrombophlebitis (choice A) is not typically associated with chlorothiazide use. Hyperactive reflexes (choice B) and hypoglycemia (choice D) are also not commonly linked to this medication. Therefore, monitoring for muscle weakness is crucial when a client is prescribed chlorothiazide.

4. A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take?

• A. Administer a small test dose before giving the full dose
• B. Infuse the medication over 30 seconds
• C. Monitor client closely for hypertension
• D. Administer cyanocobalamin as an antidote if toxicity occurs

Correct answer: A

Rationale: The correct action the nurse should plan to take when preparing to administer iron dextran IV is to administer a small test dose before giving the full dose. This is done to assess for any allergic reactions that the client may have to the medication. Choice B is incorrect because iron dextran should be infused slowly over a longer period, typically over 1-2 hours to reduce the risk of adverse reactions. Choice C is incorrect because iron dextran administration is more commonly associated with hypotension rather than hypertension. Choice D is incorrect because cyanocobalamin is not used as an antidote for iron dextran toxicity; instead, treatment for iron toxicity may involve supportive care, chelation therapy, or in severe cases, iron antidotes like deferoxamine.

5. A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects?

• A. Ecchymosis
• B. Decreased urine output
• C. Increased blood pressure
• D. Dizziness

Correct answer: D

Rationale: The correct answer is D: Dizziness. Zolpidem is known to cause dizziness, especially in older adults. This adverse effect can increase the risk of falls and injuries in the elderly population. Monitoring for dizziness is crucial to ensure patient safety. Choice A, Ecchymosis, is the development of bruising and is not a common adverse effect of zolpidem. Choices B and C, Decreased urine output and Increased blood pressure, are not typically associated with zolpidem use. Therefore, they are incorrect choices in this scenario.

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